Idarucizumab– PRAXBIND Reverses Anticoagulant Effects of Dabigatran Interview with:

Dr. Charles Pollack MD MA Thomas Jefferson University Philadelphia, PA 19107

Dr. Charles Pollack

Dr. Charles Pollack MD MA
Thomas Jefferson University
Philadelphia, PA 19107 What is the background for this study? What are the main findings?

Dr. Pollack:: We are continuing research on PRAXBIND in the ongoing global phase III patient study, RE-VERSE AD™. RE-VERSE AD includes two groups of dabigatran patients: those who had serious bleeding or those who required an urgent procedure.

At ACC, we presented results from an updated interim analysis from 123 patients enrolled in RE-VERSE AD™, which showed a single 5g of PRAXBIND immediately reversed the anticoagulant effect of dabigatran in all patients evaluated.

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Marijuana Use and Short-Term Outcomes in Patients Hospitalized for Acute Myocardial Interview with:

Lori A. Walker, PhD University of Colorado Dept. of Medicine/Cardiology, Aurora, CO 80045

Dr. Lori Walker

Lori A. Walker, PhD
University of Colorado
Dept. of Medicine/Cardiology,
Aurora, CO 80045 What is the background for this study?

Dr. Walker: Marijuana use is increasing worldwide, in part due to local changes in legal status. Concomitantly, there has been an increase in case studies reporting adverse cardiac events associated with marijuana use. However, little is known about the impact of marijuana use on cardiovascular outcomes. Therefore, the aim of this study was to quantify outcomes in a retrospective analysis of hospitalized patients with acute myocardial infarction (AMI) with reported marijuana use at the time of admission. Administrative hospital records for 8 states between 1994-2013 were screened for adults (age > 18 years) with a diagnosis of AMI. Clinical profiles and outcomes in patients with reported marijuana use were compared to patients with no reported marijuana use. The primary outcome was a composite of death, mechanical ventilation, cardiac arrest, intraaortic balloon pump (IABP) placement, or shock. Secondary outcomes were components of the primary outcome plus coronary angiography, percutaneous coronary intervention (PCI), and ST segment elevation myocardial infarction (STEMI). What are the main findings?

Dr. Walker: Associations between marijuana, patient characteristics, and outcomes were determined using step-forward multivariate logistic regression which revealed that marijuana using patients were more likely to be younger, African-American and to use tobacco, cocaine/methamphetamine or alcohol than the control group. Accounting for age, race, and other risk factors such as coronary artery disease, hypertension, tobacco, hyperlipidemia and diabetes mellitus, multivariate logistic regression suggested that marijuana-using patients were less likely to die in-hospital (OR 0.83, 95% CI 0.68-1.00) post AMI but more likely to require mechanical ventilation (OR 1.19, 95% CI 1.06-1.33). What should clinicians and patients take away from your report?

Dr. Walker: Clinicians and patients should be aware that there are likely direct effects of cannabinoids on the cardiovascular system. This preliminary study underscores the need for further basic science research. What recommendations do you have for future research as a result of this study?

Dr. Walker: There is a strong need for basic science research aimed at elucidating the signaling pathways evoked by cannabinoids in both cardiac and vascular smooth muscle. Additionally, prospective clinical research aimed at quantifying the effects of marijuana use on cardiac rhythm in healthy patients and those with existing cardiac disease is essential. Thank you for your contribution to the community.


Abstract presented at April 2016 ACC

Marijuana Use and Short-Term Outcomes in Patients Hospitalized for Acute Myocardial Infarction Cecelia P. Johnson-Sasso, David Kao, Lori A. Walker, University of Colorado, Aurora, CO, USA
Cecelia P. Johnson-Sasso; David Kao; Lori A. Walker

J Am Coll Cardiol. 2016;67(13_S):569-569. doi:10.1016/S0735-1097(16)30570-8

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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Lori A. Walker, PhD (2016). Marijuana Use and Short-Term Outcomes in Patients Hospitalized for Acute Myocardial

Women With Obstructive Coronary Artery Disease Have Higher Mortality Than Men Interview with:
Nathaniel Smilowitz, MD
Fellow, Cardiovascular Disease
NYU Langone Medical Center

MeicalResearch: What is the background for this study? What are the main findings?

Dr. Smilowitz: Myocardial infarction (MI), commonly known as a heart attack, is a leading cause of death worldwide.  In the majority of patients with MI, examination of the coronary blood vessels by angiography reveals an obstruction that limits blood flow to the heart muscle.  However, some patients develop MI with non-obstructive coronary arteries (MINOCA) at angiography.  This condition is identified more commonly in younger patients and women, and in prior studies, in-hospital death after MINOCA was lower than for MI with obstructive coronary artery disease (MI-CAD).  Despite favorable outcomes associated with MINOCA, young women paradoxically have overall higher in-hospital death after MI in comparison to younger men.  Although sex differences in post-MI mortality are known to vary with age, the interaction between age, sex, and the presence of obstructive coronary artery disease at angiography on death post-MI had not been previously established.

In this study, we confirmed that in-hospital mortality is lower after MINOCA than MI-CAD and that women are more likely to have MINOCA than men.  No sex difference in mortality was observed among patients with MINOCA, but women of all ages had significantly higher mortality after MI-CAD than men.  With advancing age, mortality increased to a greater degree in patients with MI-CAD than MINOCA and in men vs. women.

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Physician Anticoagulant Strategies during PCI for Heart Attack Vary Interview with:

Eric Alexander Secemsky, M.D Research Fellow in Medicine Massachusetts General Hospital

Dr. Eric Secemsky

Eric Alexander Secemsky, MD, MSc
Fellow in Cardiovascular Medicine
Massachusetts General Hospital
Harvard Medical School
Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center What is the background for this study?

Dr. Secemsky: Strategies to reduce bleeding, such as the selective use of procedural anticoagulants, have become an integral component of current percutaneous coronary intervention (PCI) practice to decrease adverse outcomes. For instance, previous randomized clinical trials had demonstrated that use of bivalirudin, a direct thrombin inhibitor, reduces major bleeding events following PCI among patients presenting with acute myocardial infarction (AMI) compared with unfractionated heparin (UFH). These findings resulted in a major increase in bivalirudin use during PCI.

However, more recent trials have contradicted these results and created uncertainty as to the relative safety and effectiveness of bivalirudin therapy. In addition, current United States guidelines do not endorse a primary antithrombotic strategy during PCI, leaving the choice of procedural anticoagulant to the discretion of the physician operator. As such, we wanted to determine how bivalirudin was currently being used among United States PCI operators and how usage may have changed in light of these trial findings.

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